Retrospective Evaluation of Effects of Preoperative Anaemia Treatment in Gynaecological and Obstetric Surgical Patients.

OBJECTIVE: In anemic patients undergoing surgery, there is an increase in the requirement of blood transfusion, longer hospital stay and higher intensive care unit adimission. In this study we aimed to evaluate the efficacy of iv iron treatment before elective obstetric or gynecological operations retrospectively. METHODS: After obtaining approval of ethics committee, records of 5688 patients underwent either obstetric or gynecological surgery between January 1st of 2016 to December 31st of 2018 were documented retrospectively and 241 anemic cases were identified. Eighty-one anemic patients who did not receive any iv iron treatment preoperatively were excluded and 160 cases treated with either iv iron (either sucrose or ferric carboxy maltose) were included. The laboratory results including haemoglobin (Hb), MCV,MCH and serum iron binding capacities, ferritin, iron and transferrin levels were documented before (preoperative) and after iv iron treatment (postoperative 10th day) were collected from files. Difference between preoperative and postoperative Hb, MCV, MCH, TIBC, serum ferritin, iron and transferrin levels of these cases were determined. RESULTS: In 97 obstetric cases, the differences of Hb, MCV, MCH, serum iron, ferritin, iron binding capacity values before surgery and postoperative 10th day were respectively found as 1.3 g dL-1 (p=0.000); 1.9 fL (p=0.000); 0.3 pg (p=0.01); 44.4 µg dL-1 (p=0.008); 85.9 µg L-1 (p=0.009); 211.7 µg dL-1 (p=0.001). In 63 gynecologic cases, same measurements were evaluated and similar differences in Hb, MCV, MCH, serum ferritin and transferrin saturation values were 1.25 g dL-1 (p=0.000); 2.2 fL (p=0.000); 0.8 pg (p=0.000); 215.6 µg L-1 (p=0.002); 41.5% (p=0.044). Two obstetric patients and 7 gynaecologic patients were transfused erytrocyte suspensions after surgery. CONCLUSION: Efficacy of preoperative iv iron therapy in gynaecologic-obstetric patients with IDA has been demonstrated and its importance has been revisited once again.

Comparison of HE 4, CA 125, ROMA score and ultrasound score in the differential diagnosis of ovarian masses.

OBJECTIVE: To compare the value of ultrasonography (USG) score, cancer antigen 125 (CA 125), human epididymis protein 4 (HE 4) and risk of malignancy algorithm (ROMA) in differential diagnosis ovarian masses. METHODS: This prospective study was conducted between May 2012 and September 2013 in a single center. Eighty-four women who had an ovarian mass on imaging and underwent surgery were included. The diagnostic performances of CA 125, HE 4, ROMA score and USG score for ovarian cancer were analyzed. RESULTS: There were 65 (77.3 %) women with benign ovarian tumors and 19 (22.7 %) women with malignant ovarian tumors. According to receiver operating characteristic (ROC) analysis; area under curve (AUC) was 0.874 for the USG score (p < 0.001), 0.794 for the CA 125 (p < 0.001), 0.9 for the HE 4 (p < 0.001), and 0.893 for the ROMA (p < 0.001). The USG score ≥ 3 had a sensitivity of 68.4 % and specificity of 90.7 %.The CA 125 ≥ 35 IU/l, had a sensitivity of 84.2 %, specificity of 49.2 %, the HE 4 ≥ 150 pM, had a sensitivity of 84.2 %, specificity of 98.4 % and the ROMA score had a sensitivity of 84.2 %, specificity of 75.3 % CONCLUSION: The HE 4 had higher accuracy than ROMA score, USG score and CA 125, in predicting ovarian cancer. Besides, the USG score was a simple and achievable method with acceptable performance.

Effects of ritodrine hydrochloride tocolysis on echocardiographic parameters.

OBJECTIVE: Preterm delivery is a leading cause of perinatal mortality and morbidity. The aim of this study was to determine the effect of ritodrine hydrochloride, used for tocolysis and having serious cardiovascular side effects, on echocardiographic parameters. METHODS: Sixty-two pregnant women were included in our study. The study and control groups were composed of patients with preterm labor (group A, N = 30) and patients with uneventful pregnancies (group B, N = 32), respectively. While the patients in group A were evaluated before and during treatment, those in group B were evaluated only once for ejection fraction and fractional shortening of the left side of the heart with echocardiography and for the regional systolic and diastolic functions with the tissue Doppler technique. One-way ANOVA and a t-test (paired comparison) were used for statistical purposes. RESULTS: For the left side of the heart, it was shown that while fractional shortening increased with tocolysis (p < 0.05), neither the ejection fraction nor E/A ratio, showing diastolic function, changed significantly (p < 0.01). While systolic function parameters (S(asep) and S(alat)) increased due to the inotropic and chronotropic actions of the beta-mimetic agents (p < 0.05), regional diastolic function parameters (E(asep)/A(asep) and E(alat)/A(alat)) did not change (p > 0.05). CONCLUSIONS: Due to its potent inotropic and chronotropic effects, ritodrine hydrochloride increases myocardial oxygen demand significantly. Therefore, it should be used sparingly or avoided altogether in patients with ischemic or structural heart disease.

Effects of four different regimens of hormone replacement therapy on hemostatic parameters: a prospective randomized study.

OBJECTIVE: To compare the effects of four different regimens including oral and transdermal formulations with or without progestins on the hemostatic system in a prospective randomized fashion. METHODS: Eighty-eight women were randomized to four groups receiving continuous transdermal estradiol 50 microg/day (tE2), oral conjugated equine estrogen 0.625 mg/day (CEE 0.625 mg), oral conjugated equine estrogen 0.625 mg/day plus medroxyprogesterone acetate 2.5 mg/day (CEE 0.625 mg/MPA 2.5 mg), or oral 2 mg 17-beta estradiol combined with 1 mg norethistrone acetate (E2/norethistrone). The hysterectomized patients received only estrogen, and the remaining women received the estrogen plus progesterone combination regimens. As a marker of hemostatic system fibrinogen, tissue plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) levels were measured initially, and after 1 and 6 months of therapy. RESULTS: The treatment groups were well matched for baseline characteristics including age, height, weight, body mass index, and systolic and diastolic blood pressures. During the study period fibrinogen levels were below the baseline values in all groups. However, the decrease was only statistically significant in patients treated with oral 0.625 mg/day CEE. tPA levels were decreased significantly by tE2, CEE 0.625 mg, and CEE 0.625 mg/MPA 2.5 mg. PAI-1 levels were decreased significantly by CEE 0.625 mg, and CEE 0.625 mg/MPA 2.5 mg. When the effects of the four different regimens were compared using percentage changes from the baseline, no significant difference was found among the treatment groups. CONCLUSION: One of the treatment regimens resulted in a more coagulable state. Oral therapy with CEE decreased the levels of all parameters, and MPA did not impair this beneficial effect, except for in fibrinogen. Transdermal therapy had a minimal effect. No significant difference was noted among the four regimens.

Zinc and homocysteine levels in polycystic ovarian syndrome patients with insulin resistance.

In this study, our objective was to evaluating the value of serum zinc levels as an etiologic and prognostic marker in patients with polycystic ovarian syndrome. We conducted a prospective study, including 53 women with polycystic ovarian syndrome and 33 healthy controls. We compared serum zinc levels, as well as clinical and metabolic features, of the cases. We also compared serum zinc levels between patients with polycystic ovarian syndrome with insulin resistance. Mean zinc levels were found to be significantly lower in patients with polycystic ovarian syndrome than healthy controls. Multiple logistic regression analysis of significant metabolic variables between polycystic ovarian syndrome and control groups (serum zinc level, body mass index, the ratio of triglyceride/high-density lipoprotein cholesterol, and homocysteine) revealed that zinc level was the most significant variable to predict polycystic ovarian syndrome. Mean serum zinc levels tended to be lower in patients with polycystic ovarian syndrome with impaired glucose tolerance than patients with normal glucose tolerance, but the difference was not statistically significant. In conclusion, zinc deficiency may play a role in the pathogenesis of polycystic ovarian syndrome and may be related with its long-term metabolic complications.

Prenatal diagnosis of achondrogenesis type I: a case report.

INTRODUCTION: Achondrogenesis is a lethal osteochondrodysplasia characterized by hypoplasia of the bones and is associated with various anomalies varying in severity. Based on clinical, radiologic, and histopathologic features, two types are distinguished. CASE PRESENTATION: The prenatal ultrasound examination of a 32-year-old Turkish woman who was referred to our clinic at 33 weeks and 6 days of gestation revealed fetal micromelia together with several other anomalies. The female baby died shortly after birth and was diagnosed with achondrogenesis type I based on the clinical and radiographic findings. CONCLUSION: Ultrasonography is important in prenatal diagnosis and for distinguishing lethal skeletal dysplasias in order to counsel the parents about future recurrent risks. As it is a uniformly lethal disease, a definitive prenatal diagnosis of achondrogenesis may be an indication for pregnancy termination.

CD105 expression is an independent predictor of survival in patients with endometrial cancer.

OBJECTIVE: The purpose of this study was to detect the prognostic value of CD105 (endoglin) and also to compare with CD34 and vascular endothelial growth factor (VEGF) in patients with endometrial adenocancer. METHODS: Ninety patients with endometrial carcinoma, who were treated at Gazi University Hospital, were included. Staging was performed according to the FIGO recommendations. Angiogenesis was estimated by using CD105 and CD34 and tested for possible significant relation with age, stage, histologic type, grade, depth of myometrial invasion, lymphovascular space invasion, lymph node metastasis, and overall survival (OS). In addition, VEGF staining intensity and distribution were analyzed with respect to all these variables. RESULTS: The mean age at the time of diagnosis was 57.7 years (range, 28-81 years). The mean microvessel density (MVD) for CD105 was 32.87+/-19.99, and it was 55.46+/-31.25 for CD34 (P<0.001). A significant correlation was noted between these two markers (r=0.257, P=0.02). The mean VEGF score was 4.13+/-1.73, and it was significantly correlated with MV counts determined by CD105 (r=0.291, P=0.006). It was not significantly related with CD34 (r=0.031, P=0.78). With respect to clinicopathological variables, none of the comparisons was found to be significant. The mean follow-up period was 60.5 months. To analyze the prognostic value of MVD, the patients were divided into three groups with respect to quartiles (or=75%). With CD105 staining, the 5-year OS rates for patients with the highest MVD count (>or=75%) were significantly poorer than the remaining two groups (P=0.01 for both). None of the comparisons for CD34 was significant. Survival analysis for VEGF was performed by grouping patients using staining characteristics. No significant difference was noted for OS. Multivariate analysis showed that MVD determined by CD105 correlated significantly and independently with OS (P=0.02). None of the remaining variables was significant in multivariate analysis. CONCLUSION: The current study showed that CD105 is an independent predictor of survival in patients with endometrial cancer. We recommend the use of this highly specific and prognosis-related antigen in further investigations.